The Department of Health and Human Services has published final rules for essential health benefits and several other policies that clarify rules on mental health benefits.
In the rules HHS affirmed federal parity protections to mental health benefits, requiring similar pricing arrangements for traditional physical healthcare and mental and behavioral health benefits.
According to HHS, about 20 percent of health insurance consumers currently lack access to mental health services and 30 percent lack coverage for substance abuse disorders.
Following HHS's benchmark-based approach for essential health benefits, state governments selected baseline plans from products currently in the market equal in scope to a typical employer plan. Twenty-six states have selected a benchmark plan, and for the rest, by default, the largest small group market plan in each state will be the benchmark.
In response to some stakeholder comments on the costs of meeting parity mandates, HHS says that "because compliance with EHB would require compliance with the parity standards, states would not have to defray any costs associated with bringing plans into compliance because any benefits added to ensure parity would be considered part of the EHB package."
The rules also clarify certain essential health benefit provisions, outline HHS's framework for actuarial value levels and finalize a timeline for health plan accreditation in federally-facilitated health insurance exchanges.
Another essential health benefit, habilitative services, hasn't traditionally been categorized as a distinct group of services, so HHS is requiring a transitional policy for habilitative coverage that gives insurers "time for review and development of policy in this area, and to gain experience to define these benefits."
Also, HHS says it "intends to carefully monitor coverage of habilitative services across the individual and small group markets, and to use this data to inform future changes to this transitional policy."